Exploring clinical reasoning in novices: a self-regulated learning microanalytic assessment approach

Area of Science:

• Medical Education
• Cognitive Psychology
• Diagnostic Reasoning

Background:

• Self-regulated learning (SRL) is crucial for medical students' academic success.
• Understanding regulatory processes in diagnostic reasoning is key to improving outcomes.
• Prior research highlights the importance of metacognitive strategies in learning.

Purpose of the Study:

• To investigate the regulatory processes medical students use during diagnostic reasoning.
• To determine if the strategic quality of these processes correlates with educational outcomes.
• To identify specific SRL strategies that predict academic performance.

Main Methods:

• Administered a self-regulated learning (SRL) microanalytic assessment to 71 second-year medical students.
• Recorded and coded verbal responses related to forethought and performance phases of SRL during a diagnostic task.
• Utilized descriptive statistics and hierarchical linear regression to analyze SRL processes and outcomes.

Main Results:

• 90% of students monitored diagnostic strategies (metacognitive monitoring).
• Only one-third linked strategies to task goals or plans.
• Strategic planning significantly predicted course grade, GPA, USMLE Step 1, and internal medicine exam scores, even after controlling for prior achievement and verbal ability.

Conclusions:

• Most medical students recognize diagnostic strategies but fewer integrate them into goal-setting and planning.
• Developing more strategic forethought processes is associated with improved short-term and long-term educational outcomes.
• Interventions focusing on strategic planning in diagnostic reasoning may enhance medical student performance.